Medical assessment and direct admissions to a community hospital

A new tier of intermediate care services for older people is being introduced in England and one function of these services will be district general hospital (DGH) admission avoidance. Concern has been expressed that this situation might compromise a prompt medical assessment. Reports recent experience with the medical assessment of directly admitted patients to a community hospital. The records of 81 of 87 patients admitted directly to the community hospital were available. The expected contributions to the medical assessment were not achieved by general practitioners in 27 patients (33 per cent); by hospital practitioners in 56 patients (69 per cent); and by consultants in 18 patients (22 per cent). Eight patients (10 per cent) had illnesses of greater complexity than initially considered and required transfer to the DGH. Concludes that, it can be difficult to ensure a timely medical assessment for patients admitted directly to an intermediate care service and critical incident reporting of patients who require transfer to a DGH should become a routine clinical governance activity for these services.